launching the meeple, part 2

[psocoptera]

Things got really, really hard.

As early as the car ride to the hospital I had started to sometimes feel the need to vocalize - there's this idea that you're supposed to keep your sounds strong and low, if possible, because if they're high and tight you'll freak yourself out, so I decided to try a sort of low, descending "oh" on the tenth breath, which was nice. It gave me something to look forward to if seven, eight, and nine were particularly hard, and then a sense of being "over the hump" on eleven, twelve, etc. Sometime in the exam room (I think) I was starting to sometimes not be able to make it to breath ten, and was deploying my noise on five and ten; by the time I had rejected the tub (I think - my sense of exactly how my subjective memories line up with external events is pretty fuzzy, and while we have fabulous detailed timeline notes taken by Chaos, they don't include my subjective impressions, for obvious reasons) this was sometimes five through or somewhat beyond ten, and my good strong I-am-the-boss-of-this-contraction "oh" was sometimes turning into a whinier are-you-all-aware-this-really-hurts "ow".

Over the next two hours the "ow"s got louder and louder. The bathroom of the labor and delivery room was by then even more horribly and hideously far away than the bathroom down the hall had been from the exam room, and on my trips there and back I was losing my breathing entirely, just bracing myself against the wall and yelling. Around 6 pm, the midwife on duty said that on the basis of the timing and intensity of my contractions, she thought I might be entering transition (and dilated to around 8 cm), and it was feeling like what it seemed to me transition might feel like - intense, scary, more and more and more painful. I started getting the full-body shakes again because I was just so tense, even with all of Josh's "deep breath, deeep breath", I could only very occasionally manage to relax between contractions. Increasingly, I wasn't managing to keep a count going any more, and was just sort of riding my way through trying to breathe sometimes - one of my very few regrets about my labor was not getting someone else to start doing a count for me. I'm not even sure it was ever apparent to anyone else that I had been counting - I had been doing it in my head, with my breathing - but losing the count definitely made me feel that much more overwhelmed and out of control. The "ow"s were getting even higher pitched, sometimes turning into full-blown shrieks. But I was hanging on to the idea that transition was the shortest stage of labor, that it probably wouldn't go longer than 90 minutes, or maybe two hours, that it might be even shorter, that this would all be over soon, and when I did manage to drop my shoulders and unclench some of the places I kept bracing against the pain, that's what I was thinking, that I was getting through, that this was the hardest part.

Then the day shift went off and the night shift came on and the new midwife wanted to do an internal exam, as none had been done since I had been admitted. At first I just couldn't see how I could possibly comply - I knew that the second I put weight on my legs to move the required few feet up the bed I was going to be hit by a terrible contraction, and then I was going to have to endure at least one and probably several while on my back, and even though I was being hit by bad contractions anyways, this somehow seemed unbearable beyond contemplation. I can't remember what Josh said to encourage me, but eventually I conceded that I could undertake the journey, and made it up to the head of the bed in a series of small scooting increments punctuated by a couple of contractions, where I realized that I really actually could not figure out how to lift my legs onto the bed and it wasn't just fear this time. Fortunately the midwife agreed that she and Josh could lift them and swing them over for me.

Finally settled into exam position, the midwife checked me, and announced that I was at 6 to 7 cm.

I remember being furious. Here this terrible woman had taken over from my nice afternoon midwife, made me leave the one place that was at all comfortable, go through this exam, and now she was taking away all of my hard-earned progress and sending me back to 6 cm. 6 cm! I had been working so hard, fighting to not fight, to keep accepting the contrations and sink down into them and let them work, and it hurt *so* much, for *one centimeter*? And *four more* still to go? And this wasn't transition yet? Real transition was much *worse* than this?

She said I had three choices. I could try laboring in the tub, I could get an epidural, or they could break my water and see if that would speed things up. (In Chaos's notes, the first choice was "try another two hours" rather than "try the tub" - this is likely correct, but I remember it very clearly as the tub, so go figure.) In my next break between contractions (having been helped back down to the corner for the small but very precious amount of relief it gave me), I snapped at her that after my next contraction she was going to leave the room and I would decide with Josh what to do. She was gracious and reasonable about this.

I'm pretty sure I opened the conversation with Josh by saying "I don't know, I don't know", but in fact I sort of did know: I wanted the epidural. There was no way I was going back to that tub, and I felt like I was already running out of ability to cope just as things were - I was starting to get a muscle cramp in one calf, from tensing my leg, and another in one thigh, another in my back - I didn't feel like I had any physical resources that could handle things getting even more intense with the breaking of my water. And the setback in how much progress I thought I was making had just been too big - my belief that I could get through what was left was crushed under the thought of hours and hours left to go. Finally, it sounds sort of stupid to say I opted for an epidural so I wouldn't have to pee, but I was terrified of that next bathroom trip, and I couldn't help but think that if I chose the epidural, they'd give me a catheter and I wouldn't have to get up from the bed anymore.

Josh said all the right things - first, that I was strong and *could* do it, and then that I didn't *have* to, that I was making a good choice for myself, that the epidural didn't mean that everything else (pushing, breastfeeding) would necessarily fail.

What followed was something like an hour of hell. I swear, when we announced our decision, that they said something about one bag of IV fluids and fifteen minutes, although when the anaesthesiologist finally did show up, I said something about being glad he finally showed up and he said he came as soon as he was paged, so it's not entirely clear to me whether I had misunderstood something, or what. In any case, having made the decision to employ pain relief, I felt *entirely ready* to be done with the whole business of excruciating contractions (which had of course been going on this entire time.) After that first fifteen minutes, after each one, I would think that maybe that was it, and I would get my epidural soon, and then it just kept going and going... I had entirely lost the thread of my breathing and was just freefalling from contraction to contraction, screaming and begging and barely aware of anything except the idea that relief was supposed to be coming. (Later on, the nurse who was placing my IV, etc, told me it was a good thing I had gotten the epidural so that I would stop bothering the people next door by being loud, or words to that effect. Pissed me off then and still does a bit - to paraphrase Avenue Q, I totally think you can be as loud as the hell you want when you're having a baby, and if the hospital thinks that's a problem they can invest in soundproofing between the rooms. I'm not saying I particularly *wanted* to be screaming but it seems ridiculous to me to think that I was supposed to be thinking about being considerate of my neighbors at that point!)

Adding to my difficulties, I had one last epic trek to make: because of the layout of the room and locations of some of the equipment, I had to be sitting on the other side of the bed to get the epidural. When I heard this, they might as well have been telling me I had to get to the far side of the moon, for how possible it seemed. And in fact I have no idea how I did get over there - I feel like I remember a fair bit about most of the rest of my labor, but I have no memories of making that move, just the general blur of unhappiness. I recall that getting my IV was surprisingly painful; my next clear memory is of being bent over prematurely by the nurse (you have to curl tightly forward to get the epidural) and of pleading to be allowed to straighten up in the current contraction until they were actually going to start doing something, which the nurse refused and then anaesthesiologist, thankfully, let me do. It wasn't quite so bad to be bent once I knew it was actually *necessary*, and the actual getting of the epidural was not a big deal, on the scale of bodily events at the time (although that was never an aspect of the epidural that was an issue for me, except for the risk of side effects.)

Finally, finally, it started to kick in, and I got my catheter and various monitors. (Ironically, I ended up feeling my contractions as bladder pressure, so I was not entirely relieved of the "feeling the need to pee" issue, but it was indescribably better than feeling them as contractions.) Someone mentioned that the baby's heartbeat looked good and I realized that it was the first time I had thought about the baby in hours - oh, yeah, the baby! The anaesthesiologist came back after a bit to check on things and said he hoped I wasn't having epidural remorse, that sometimes women felt guilty about it once it was going. I had, and have, no remorse: I made a choice based on the specific reality of the situation. In my ideal labor, the situation might have been different, but, honestly, I was, and am, very aware of how incredibly lucky I am that my body was able to make and grow a baby with a minimum of technical assistance. If it was going to not be so great at something, "labor" rather than "pregnancy" was totally my preference anyways. I'm not sorry I waited as long as I did to get the epidural either, though - I absolutely would have regretted "tagging out" before finding out whether I really needed to or not, and I'm glad to have had the experience of unmedicated labor that I did.

The one thing I feel bad about is people being impressed or sympathetic about my 27 hours of labor. Once I got the epidural, I spent the next seven hours resting in bed, warm and safe and calm, sometimes sleeping and sometimes just resting. It feels fraudulent to take credit for those hours as "labor". The person who really deserves to be congratulated or pitied is Josh, who was not able to sleep, with all the many things in my room going "bzzt" or "whirr", and who was thus awake for 24 straight hours of those 27, right there talking me through every. single. contraction. (I think Chaos might have gotten him to eat something once I had the epidural in; I'm sort of hoping he'll post some comments about his own experience through all of this, once I finally get this very long birth story posted. Chaos was herself there for a good 15 hours or so and I think for awhile during the epidural part she didn't even have a reclining chair - I think I was the most comfortable of us during that part, even with the various itching from the epidural, weirdly numb skin on my left leg, etc.)

The other reason I feel validated in my decision to opt for the epidural is that, as I just mentioned, I was in labor for *seven more hours* before even reaching the pushing stage - the epidural did slow down my contractions, but even if you assume it, say, halved my rate of progress, I still had a lot of labor left to go. I was at 9 cm after about five hours and the midwife did end up breaking my water at that point - it was bulging down pretty far but was refusing to break on its own, and it seemed like a pretty reasonable intervention, given that I was at the point where it was supposed to have broken anyways and I was hoping to actually get on towards having the baby at some point.

The water breaking was around 2:45; I was pronounced ready to push around 4 in the morning. (This is where Chaos's timing notes are the most necessary, because I never would have guessed that I was pushing for over two hours.) I think I'm going to leave that, and the actual birth, for a third part to this series, since I've been working on this one for a week and a half now and it would be nice to get something actually posted. So, uh, stay tuned for the conclusion, although I think it's more or less clear at this point how it all turns out. ::grin::

Comments

[rebeccapaul.livejournal.com]

I just wanted to let you know how happy I am that you're sharing this (and that you made it through all of this!)... I'm sort of laboring vicariously through you (since I skipped labor entirely).

[gannet.livejournal.com]

Hate to be a cliche, but me too.

[irilyth]

> I'm sort of hoping he'll post some comments about his own experience through all of this

Indeed! Hi. :^) It seems weird to refer to you in the third person here, so I'll go for second for now.

> one of my very few regrets about my labor was not getting someone else to start doing a count for me. I'm not even sure it was ever apparent to anyone else that I had been counting

It wasn't to me, and I was paying pretty close attention. :^/ This whole part was really intense for me, because I was totally focused on you and your breathing, and trying to read how close you were to the end of a contraction, so I could shift from "you can do it" to "almost done", the latter of which seemed helpful anyway.

> The bathroom of the labor and delivery room was by then even more horribly and hideously far away than the bathroom down the hall had been from the exam room

It wasn't actually physically farther away, but I don't doubt that it felt that way. :^(

> I can't remember what Josh said to encourage me

Possibly just "come on, we're going to do it now". :^) Figuring out when you needed someone to figure out what you wanted, and when you needed someone to tell you what to do, was also a fairly intense on-the-fly learning experience.

> Finally settled into exam position, the midwife checked me, and announced that I was at 6 to 7 cm.

FWIW, I was also really crushed by this. I don't know if you were aware of it at the time, but I was leaning pretty hard on "this is totally it, this is the really hard part, you just have to make it through this really hard part and then it'll all get good, that last centimeter is the hardest, you're totally almost there". My first couple of thoughts were "the midwife must be wrong, she looks younger than the first one, maybe she underestimated, maybe she's lowballing, maybe ..." But when she started talking like she thought the epidural would be a good idea, which their practice generally doesn't encourage as a first resort, it seemed pretty clear that she wasn't kidding.

> I remember being furious.

You were really unhapy. I couldn't necessarily tell at the time if it was more like fury or more like despair, possibly a lot of both. :^(

> In Chaos's notes, the first choice was "try another two hours" rather than "try the tub"

I remember it as "another couple of hours, in some different positions", and she probably did mention the tub more than once, since it's generally something that people say is helpful, and it was clear that you hadn't tried it in a while or for long. (But I think you totally tried it long enough -- for whatever reason, it was totally not working for you, and not going to work for you unless it had been like a jacuzzi tub that you could sit up in.)

[glassonion]

Mentioned this to Amy in e-mail, but:

It wasn't to me, and I was paying pretty close attention. :^/ This whole part was really intense for me, because I was totally focused on you and your breathing, and trying to read how close you were to the end of a contraction, so I could shift from "you can do it" to "almost done", the latter of which seemed helpful anyway.

I think you noticed at the time that she was counting, at least when she did it out loud. There were a few contractions where one or both of us counted along. But i couldn't have helped keep a count because contractions started earlier than i could tell. So the couple of times i tried saying numbers aloud and Amy chimed in later, my number was always off (and i don't think Amy could hear me anyway).

[irilyth]

> I'm pretty sure I opened the conversation with Josh by saying "I don't know, I don't know", but in fact I sort of did know: I wanted the epidural.

This was another really hard part for me, because I could tell that you wanted it, but I couldn't tell at first how much you also wanted not to "give up", and the cliche is totally that the laboring woman who thinks she's going to go unmedicated shouts "get me MORPHINE!" at the first contraction. And it was clear that you weren't there, but I wasn't sure at first whether you couldn't go on, or just didn't want to go on. That was the main thing that I was trying to read, because I figured that if you could go on, but didn't want to right then, you'd feel later like you wished you had.

> I was starting to get a muscle cramp in one calf, from tensing my leg, and another in one thigh, another in my back

This was really what convinced me: You were in a lot of pain that wasn't directly related to the contractions per se, and it was clear that you weren't able to relax between contractions, and that wasn't going to change any time soon, and that your legs and back being in a lot of pain was definitely not part of the plan. I was looking for signs that it hurt right now, but would get better, but what I was seeing was signs that it hurt a lot right now and had almost no prospect of getting better for at least two or three hours.

> What followed was something like an hour of hell.

Yeah, this was fucked up. :^( I think the nurse was just way out of synch with the anesthesiologist, because she originally said something about only needing to give you one bag of fluid (which led to her 15 minute estimate), and then later was talking as if she would normally have given you three and it was quite astonishing that they'd gotten away with only two and that it had only taken 45 minutes to do that. And she definitely said something about wondering where the anesthesiologist was, and he definitely said something very clear about how he came as soon as he got the call and totally could have come earlier. And then later when she made you bend all the way forward in that awful position, she was holding you there and holding you there until the anesthesiologist finally looked up and said something very much like "you can let her sit up, I'm still prepping and won't need her in that position for another few minutes". I don't know what was going on there, but it sucked -- that was the point when I most wanted to hit someone. :^p You were clearly going to be in a certain amount of unavoidable pain and discomfort, but when people are doing stupid things that make it worse, grr.

> I had to be sitting on the other side of the bed to get the epidural.

We basically just dragged you over there while you cried and struggled weakly the whole time. :^(

> I'm not sorry I waited as long as I did to get the epidural either, though

Me neither -- I think that was totally the right decision, because if that had been transition, and you had been at 9 or 10 cm by the time the night shift midwife showed up, you could totally have made it the rest of the way without it. If you had started asking for an epidural before the midwife got there, I would've reminded you (really nicely and supportively :^) that you couldn't get an epidural once you were in transition and you'd just have to push through it and you were totally almost there and so on.

> I think Chaos might have gotten him to eat something once I had the epidural in

Yeah, and one or the other of you tried to get me to eat something earlier, which I refused and almost snapped at someone about, because taking a break to eat then would've meant abandoning you to fight the contractions alone, and I would do anything for love, but I won't do that.

[glassonion]

Yeah, and one or the other of you tried to get me to eat something earlier, which I refused and almost snapped at someone about, because taking a break to eat then would've meant abandoning you to fight the contractions alone, and I would do anything for love, but I won't do that.

Yeah, i'm sorry about this.

Until that exchange, i hadn't quite realised how focused you were and needed to be, and had been thinking, "My job is to make sure Josh has things he needs so he can focus on Amy", so i was looking for times when things were un-intense enough that i could sit with Amy through a couple of contractions and you could get water, food, bathroom breaks, etc.

Really, the time to pester you to eat something was more like 17:00, and the argument was more like, "Grab a Clif bar now because later there will be an N-hour interval in which you really can't go anywhere". I didn't really catch on that that would happen (or that it would happen sometime other than during pushing) until we were already in that interval, though in retrospect it seems obvious.

[myalexandria.livejournal.com]

well, live and learn :)

[psocoptera.livejournal.com]

And it was clear that you weren't there, but I wasn't sure at first whether you couldn't go on, or just didn't want to go on. That was the main thing that I was trying to read, because I figured that if you could go on, but didn't want to right then, you'd feel later like you wished you had.

I can totally see why you were interested in this distinction, but I think it's a somewhat murky one. At least, I would like to think that if I had been told that for some reason I *could not* get any medical pain relief, I would have accepted that and kept my shit a little bit more together than I did once I was placing my hopes on medication. I mean, a) it's not like I could have *stopped* in any case, I was more or less going to have to keep laboring no matter what I wanted, and b) some considerations never came into play, in what actually happened, that I'd like to think would have affected what I thought I "could" do... if for instance there had been some reason that getting meds would be risky for the baby, I think what I could do for the baby would in fact have been rather different than what I could do for my beliefs about the general costs and benefits of epidurals.

[glassonion]

So i have some perhaps-completely-inaccurate theories about this. This comment contains minor spoilers for part 3; avert your eyes, folks.

I think that by that point in labor, your pain receptors were basically firing on all cylinders. My understanding about pain is not very sophisticated, but a lot of things affect how it's perceived. Basically, because you'd been having contractions for so long, you were feeling pretty much every sensation as horrible pain by that point. This was probably related to why you found the IV so painful, as well as to the back and leg stuff. You were also extremely touch-sensitive at that point (probably related too), like when the nurses needed to move the monitor and stuff.

It seems to me the risk was that, if you'd endured that for several more hours unmedicated, followed by over two hours of being manhandled by four people who were supporting you while you pushed, you might well have been miserable enough not to be able to appreciate the actual birth of your child. That would have been worth enduring in some circumstances (such as medical risk for one of the participants, as you note), but, insofar as it was one of the most fucking incredible things i have ever seen, i'm inclined to think that not being able to be mentally present for it due to pain would have been a big loss.

I will finish by disclaiming again that i may be totally wrong about any or all of this.

[gannet.livejournal.com]

Some hospital staff can be such jerks. (I'll never forget how, while I was miscarrying my first pregnancy, I drove by myself to the nearest emergency room, bleeding and in some of the worst pain I've ever felt (physical and emotional), only to have the guy who was taking my information tell me I should have driven twenty minutes further to the hospital where my doctor practiced!)

Fortunately, other hospital staff can be really supportive.

[belecrivain.livejournal.com]

wow.

My prenatal yoga class reads a "birth story" from a former student at the close of every class, and the first two (I had to skip the third class for seder) were both "I didn't need pain medication, go me, it was such an empowering experience!" Which is probably helpful for most of the women in the class, who are hoping to labor empoweringly, as it were, but left me sort of annoyed: as I have ranted before, it's not necessarily helpful for me to hear that unmedicated labor is the pinnacle of empowerment, since the indications seem to be that the best thing I can do for me is accept the planned C verdict. All of which is to say, it is helpful for me (she says selfishly) to hear that I am not some freak surrounded by women laboring in full harmony with their bodies, or whatever.

And I am glad y'all are on the other side of this.

[jaipur.livejournal.com]

Jeepers, what an ordeal to go through. Though reading the feedback from Josh and Chaos shows an incredibly sweet and loving set of interactions, so go you guys. :)

Might not want to show this entry to Juniper down the road, though, if you ever want grandkids. ::chuckle::

[psocoptera.livejournal.com]

Heh, for me, this is a positive and uplifting story. ::grin:: Yes, it was a really difficult experience and I've never been in sustained pain like that, and there was the one massive disappointment when we realized it was not going as we had hoped, but a) I got this baby!! and b) I went into labor with this idea of exploring the outer limits of what I could deal with, and while it turns out they didn't stretch far enough to actually birth the baby, I don't regret having gone there and found that out. I mean, my experiment did yield the data in which I was interested, that's a successful outcome in my book.

[belecrivain.livejournal.com]

[quibble] You did, in fact, birth the baby, regardless of what medical interventions were needed. [/quibble]

[(Anonymous)]

Thanks so much for posting this. BTW robert wants to know what kind of prep classes you took.

[psocoptera.livejournal.com]

We took a childbirth class offered by the midwives; two days of about 6 hours each day, covering basic information about the physical process of labor, the various medical options, some ideas about positions and massage, and some basic relaxation practice. I also did weekly prenatal yoga for several months which is where I got all the breathing and relaxation techniques I actually used.

[bhadrika.livejournal.com]

Thanks for sharing this -- lots of memories, lots of sympathetic groans and snorts. I totally remember the rage reaction to hearing a mediocre dilation measurement. My midwives would always stall -- the first time, they seemed lazy, but the second time she really was good about not wanting me to feel like the work was for nothing -- and pointed out there's also effacement (thinning), so a change from 5 to 6 cm might come with a 30% to 90% effacement change, and thus mean a lot of progress. Or so she said.

I hate the tendency to push epidurals -- "no need for anyone to be in pain" as if there's no potential side effects, and I also hate the tendency to push absolute avoidance of medicine -- "drugs = failure." Could society please make friends with the middle ground? Sheesh, like I said -- natural childbirth is when there's a pregnant woman and a baby comes out; everything else is just details and plumbing. Your labor lasted long enough and hurt badly enough to make the epidural make perfect sense -- if that makes you a "failure" in the birth department, what does my magical ability to lose all use of one leg for two months after each kid say about me?

And I have to say, that nurse (several, actually) sound horrible. Part of me wishes I could have been there to help out, but part of me knows I would have won no friends with the nurses. Complaining that you were too loud? Sheesh! Damn right they can get soundproofed rooms if that matters to them.

[psocoptera.livejournal.com]

Other than those two things, the nurse was quite nice - particularly helpful to me during the pushing phase, which I haven't written up yet. I think she was likely just trying to make sympathetic chit-chat with the noise comment - now if she had said it *before* we had decided on the epidural, that would have been quite out of line.

Like I was commenting to jaipur above, I definitely don't think of my labor as a failure, or feel that I failed - I wanted to find out what it would be like, and what I could do, and I did. Sure, in my fantasy labor, there would have been less pain and more coping, such that the balance stayed on the not-choosing-drugs side, but "conforming to fantasy" was not a requirement for success here.

[prof-fran.livejournal.com]

Ed reminds me that one of the things we hated most with the birth of our first was the shift changes of nurses. Not that it would be better for one shift to stay on until you had the baby because then everybody would be tired and cranky (and some of the changes were for the better) but it was somewhat frustrating in the middle of all the pain and waiting to have to meet someone new and explain yet again how I was doing.

I remember being chided by the phlebotomist for my poor veins (which are really bad; the long line they put in also failed) and that before my epidural they gave me something they TOLD me would keep me from throwing up when they put in the epidural. In fact, it made me throw up immediately; I suspect I would have resisted it if they had said "this will make you puke now". I remember hating it when they broke my water to see if this would speed the labor; I felt as if I had peed the bed. I guess what I'm remembering with the first birth was feeling not very in control at any point in the process.

With the second, I stayed home working on my PowerPoint for classes that I'd be missing right up until contractions were about 1/2 hour apart and they said come in because we had a scheduled c-section (and were running a week early). And the day after M. was born, I gave three phone interviews for jobs while lying in bed in the hospital. Got call-backs on two of them, too. I may perform better in some situations when I am dosed to the gills...